Exploring the Social Determinants of Public Health with Robert Wood Johnson Foundation

By Bill Frist, M.D.

NOTES FROM THE ROAD | Scotland—Survival of men and women in Scotland is the worst in Western Europe. So is their general health. Why is that? What is being done? How successful are the new, bold initiatives that were launched in 2010?

I am in Glasgow with the board of the Robert Wood Johnson Foundation (RWJF) to explore these fundamental questions to better inform us to shape what we can do in Nashville though our bold new, community wide initiative NashvilleHealth to improve our current poor population health at home.

Scotland’s ongoing commitment since 2010 to make Scotland the best place in the world to raise a child, with the long-term goal of improving the social and health outcomes over the course of a generation, is similar to our efforts at NashvilleHealth.

And Scotland shares many of the same political, economic, and demographic profiles as the US, and Nashville.

Glasgow is about the size of Nashville: home to 600,000 people, with another 600,000 in the surrounding metropolitan area. Nashville has worse health than similar cities like Charlotte, Austin, and Denver; Glasgow has worse health compared to other UK cities with similar characteristics, such as Liverpool and Manchester. Smoking rates are about 23% for both cities. And like Nashville, within the Glasgow metropolitan area, there are even greater disparities.

In both Nashville and Glasgow, explanations for these disparate health outcomes include inequities in income and educational attainment but also social isolation, excessive tobacco and other substance abuse, unhealthy diet, and high rates of adverse childhood experiences.

A starting point for my investigations in Glasgow is similar to what we as a community are doing through NashvilleHealth at home: examine how various sectors are working together to improve the outcomes of existing programs that are aimed at helping families and children in health need.